Prognostic value of carotid intima-media in the short- and long-term mortality in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study

Physical Activity and Survival After an Acute Coronary Syndrome: Data From the ERICO Study

BACKGROUND

Due to enhancements in health care, the number of individuals who survive an acute coronary syndrome (ACS) event is rising. In this population, the impact of physical activity on long-term survival is still a matter of debate. We aimed to analyze the association between the level of physical activity during the first 4 years of follow-up and survival.

METHODS

We analyzed data from 692 patients admitted due to an ACS event in a community hospital in Brazil. Physical activity was assessed using the long version of the International Physical Activity Questionnaire at 30 days, 180 days, and yearly after the first event. Mortality data were obtained using phone contacts, medical records, and official death documents. We built time-dependent Cox proportional hazard models to analyze whether physical activity levels during follow-up were associated with survival.

RESULTS

Our main sample had 280 (40.5%) women and a mean age of 62.6 (12.5) years. In all assessments, 50.8% to 74.9% of study participants had physical activity levels below recommendations for healthy individuals. Physical inactivity increased the risk of death (hazard ratio [HR], 1.82; 95% confidence interval, 1.13-2.92). There was no statistically significant survival difference between insufficiently active and active participants.

CONCLUSIONS

Many individuals who survive an ACS event have poor physical activity levels. Physical inactivity after an ACS event significantly increases the risk of death. Our findings provide additional support to reinforce, in clinical practice, the benefits of physical activity in individuals who survive an ACS event.

Association Between Carotid Intima-Media Thickness and Novel Lipid Parameters in Hypertensive Patients

INTRODUCTION

Carotid Intima-Media Thickness (IMT) is a marker of subclinical atherosclerosis and cardiovascular risk. Dyslipidemia is a well-established risk factor for atherosclerosis and novel lipid parameters have recently emerged.

AIM

The aim of our study was to assess the association between IMT and novel lipid parameters in hypertensive patients.

METHODS

We analyzed the IMT of 848 hypertensive patients followed at the Hypertension Unit of San Gerardo Hospital (Monza, Italy). Classic (total, HDL, LDL and non-HDL cholesterol and triglycerides) and novel indices (non-HDL/HDL, LDL/HDL, total cholesterol/HDL, log triglycerides/HDL and triglycerides-glycemia index) were measured and calculated.

RESULTS

Univariable analyses showed a significant correlation between IMT and most lipid parameters. Multivariable linear regression with IMT as continuous dependent variable revealed a significant association with total cholesterol (β = 0.108, p = 0.001), LDL cholesterol (β = 0.119, p < 0.001), non-HDL cholesterol (β = 0.126, p < 0.001), non-HDL/HDL (β = 0.134, p < 0.001), LDL/HDL (β = 0.140, p < 0.001) and total cholesterol/HDL (β = 0.134, p < 0.001). Logistic multivariable regression with IMT categorized as ≥ or < 0.9 mm demonstrated a significant association with total cholesterol (OR = 1.100 per 10 mg/dL increase, p = 0.003), LDL cholesterol (OR = 1.130 per 10 mg/dL increase, p = 0.001), non-HDL cholesterol (OR = 1.110 per each unit increase, p = 0.001), non-HDL/HDL (OR = 1.368 per each unit increase, p = 0.002), LDL/HDL (OR = 1.583 per each unit increase, p = 0.001) and total cholesterol/HDL (OR = 1.368 per each unit increase, p = 0.002).

CONCLUSIONS

Carotid IMT is significantly associated with various lipid parameters, with the strongest association observed for non-HDL/HDL, LDL/HDL and total cholesterol/HDL.

Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary syndrome

BACKGROUND

Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment.

METHODS

NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV). Long-term outcomes included major adverse cardiovascular events (MACE), a composite of death, reinfarction, urgent revascularization, stroke/transient ischemic attack, and significant bleeding.

RESULTS

Recruitment resulted in 214 patients assessed for LnRHI, 190 patients assessed for CIMT and 245 patients assessed for cfPWV. For LnRHI group (median follow-up 4.73 years [IQR: 1.41-5.00]), Cox regression analysis revealed a trend towards increased risk of MACE (HR: 1.24 [95% CI: 0.80-1.93]; P  = 0.328) and mortality (HR: 1.49 [95% CI: 0.86-2.59]; P  = 0.157), but no significance was reached. No difference for other components of MACE was found. For CIMT group (median follow up 4.74 years [IQR: 1.55-5.00]), no statistically significant difference in MACE was found (HR: 0.92 [95% CI: 0.53-1.59]; P  = 0.754). Similarly, for cfPWV group (median follow-up 4.96 years [IQR: 1.55-5.00]), results did not support prognostic significance (for MACE, HR: 0.95 [95% CI: 0.65-1.39]; P  = 0.794).

CONCLUSION

Endothelial function, CIMT and vascular stiffness were proven unsuitable as strong prognostic predictors in older patients with NSTEACS.

CLINICAL TRIAL REGISTRATION

NCT01933581.